“To date, an online yoga program specifically for people with knee osteoarthritis has not been investigated,” they added. “The need for such evidence-based packaged online exercise programs is highlighted in the 2020 U.S. National Public Health Agenda for Osteoarthritis.”

To investigate the impact of unsupervised, online yoga courses in patients with knee OA, Bennell and colleagues conducted a randomized, controlled trial using a two-group superiority parallel design. Patients were eligible for inclusion if they met the National Institute for Health and Care Excellence OA clinical criteria, and reported knee pain on “most days” of the previous month as well as for at least 3 months. Additionally, patients needed to rate their pain at an average of four out of 10 on a walking pain scale, and have internet access.

Patients were excluded if they had a knee injection in the previous 6 months or scheduled an appointment with an orthopedic surgeon in the next 6 months, underwent knee replacement on the impacted knee or had systemic or inflammatory arthritis-based conditions.Patients who exercised regularly in the previous 6 months or who could not walk at all were also excluded.

Patients randomized into the control group were provided access to a website built for the purposes of the study, which included information on OA, treatment options and the impact of exercise, physical activity and weight loss in managing OA pain. The site also featured advice on pain management and improving sleep, as well as stories from other patients with OA. Meanwhile, patients randomized into the test group were given access to a website featuring the same information as the control site, plus a self-directed, 12-week, unsupervised, progressive yoga course.

In addition, participants self-reported responses to a questionnaire administered at baseline, 12 weeks and 24 weeks. The 12-week survey acted as the primary time point for analysis purposes, the researchers wrote. The primary outcomes were 12-week changes reported in pain and physical function. Pain was assessed using an 10-point scale, while function was examined using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

In all, 195 patients reported 12-week responses while 189 patients recorded 24-week responses. Compared with the control group, patients who participated in the unsupervised online yoga program demonstrated improved physical function (mean difference in change = –4; 95% CI, –6.8 to –1.3), according to the researchers. Additionally, knee stiffness, quality of life and arthritis self-efficacy were improved in the yoga group, compared with the control group. However, these improvements were not sustained through 24 weeks, they added.

“Our results are promising, but further research is needed to fully establish the effects of unsupervised online yoga and to potentially improve on our program in order to enhance treatment benefits,” Bennell and colleagues wrote. “Our program was low-intensity, emphasizing physical poses and movement, with less or no inclusion of elements such as deep relaxation, chanting, singing and meditation.”

References:

• Brinsley J, et al. J Altern Complement Med. 2021;doi:10.1089/acm.2021.0062.
• Lauche R, et al. Curr Rheumatol Rep. 2019;doi: 10.1007/s11926-019-0846-5.